Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis.

BACKGROUND: Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation. METHODS: Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques. DISCUSSION: The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae. TRIAL REGISTRATION: Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023).

Spatial patterns of historical crop yields reveal soil health attributes in US Midwest fields.

Attaining high crop yields and increasing carbon storage in agricultural soils, while avoiding negative environmental impacts on water quality, soil erosion, and biodiversity, requires accurate and precise management of crop inputs and management practices. The long-term analysis of spatial and temporal patterns of crop yields provides insights on how yields vary in a field, with parts of field constantly producing either high yields or low yields and other parts that fluctuate from one year to the next. The concept of yield stability has shown to be informative on how plants translate the effects of environmental conditions (e.g., soil, climate, topography) across the field and over the years in the final yield, and as a valuable layer in developing prescription maps of variable fertilizer rate inputs. Using known relationships between soil health and crop yields, we hypothesize that areas with measured constantly low yield will return low carbon to the soil affecting its heath. On this premises, yield stability zones (YSZ) provide an effective and practical integrative measure of the small-scale variability of soil health on a field relative basis. We tested this hypothesis by measuring various metrics of soil health from commercial farmers' fields in the north central Midwest of the USA in samples replicated across YSZ, using a soil test suite commonly used by producers and stakeholders active in agricultural carbon credits markets. We found that the use of YSZ allowed us to successfully partition field-relative soil organic carbon (SOC) and soil health metrics into statistically distinct regions. Low and stable (LS) yield zones were statistically lower in normalized SOC when compared to high and stable (HS) and unstable (US) yield zones. The drivers of the yield differences within a field are a series of factors ranging from climate, topography and soil. LS zones occur in areas of compacted soil layers or shallow soils (edge of the field) on steeper slopes. The US zones occurring with high water flow accumulation, were more dependent on topography and rainfall. The differences in the components of the overall soil health score (SHS) between these YSZ increased with sample depth suggesting a deeper topsoil in the US and HS zones, driven by the accumulation of water, nutrients, and carbon downslope. Comparison of the field management provided initial evidence that zero tillage reduces the magnitude of the variance in SOC and soil health metrics between the YSZ.

[Determinants of the utilization of cancer screening among older adults in Saxony-Anhalt-What is the influence of health literacy?] / Determinanten der Inanspruchnahme der Krebsfrüherkennung von älteren Erwachsenen in Sachsen-Anhalt ­ Welchen Einfluss hat die Gesundheitskompetenz auf die Inanspruchnahme?

BACKGROUND: In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region. METHODS: In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (n = 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use. RESULTS: Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation. CONCLUSION: The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education.